FIELD REFERENCE
Full criteria & treatment guidance
Do not decompress on one finding alone
- Version unresolved: the public procedure index checked October 20, 2026 still links the adult 2022 and pediatric 2019 PDFs. July 2026 committee revision materials describe a planned October 2026-April 2027 implementation window; those materials do not establish finalized adoption or the procedure authorized by your agency. Confirm the current PR-060/065 version, training and equipment with agency medical direction before relying on the older procedural details below. This guide remains a draft.
- For adults/adolescents, absent breath sounds or shortness of breath alone are not sufficient. The suspected tension-pneumothorax findings must be associated with hypoxia or hemodynamic instability.
- Do not reinsert the needle into an indwelling catheter; the needle can shear the plastic catheter.
- Base contact is required unless the documented MCI, remote-rescue, or tactically unstable-scene exception applies.
Confirm the indication
- Adult/adolescent: use needle thoracostomy for suspected tension pneumothorax when qualifying findings are associated with hypoxia or hemodynamic instability. Pediatric: use it for tension pneumothorax causing hemodynamic instability in a chest-injury patient.
- Adult/adolescent findings can include blunt or penetrating chest injury, absent breath sounds on the suspected side with breath sounds present on the opposite side, distended neck veins, circulatory collapse, respiratory arrest, or progressive dyspnea.
- Pediatric findings can include chest injury, unilateral absent breath sounds, progressive dyspnea or respiratory arrest, poor perfusion, and altered mental status.
Base contact & equipment
- Make base contact before decompression. In an MCI, remote rescue, or tactically unstable scene, proceed without base contact and document the circumstances.
- Adult/adolescent: use a 3.25-inch ARS 10-gauge catheter-over-needle device or a minimum 2.5-inch 14-gauge catheter-over-needle device, plus antiseptic and a sterile occlusive dressing.
- Pediatric: at an estimated weight of 40 kg or less, use a 1.25-inch 16-gauge catheter-over-needle device. Above 40 kg, use an adult decompression needle at least 2.5 inches long.
Landmark & decompress
- Explain the procedure when the patient is conscious and able to understand. Identify the second intercostal space at the midclavicular line and prepare the site.
- At the lower aspect of the second intercostal space, insert perpendicular to the chest wall with steady pressure.
- Advance until a rush of air, a pop or giving-way sensation, or air, blood, or fluid through the needle confirms entry into the chest cavity.
- Adult/adolescent: remove the needle and leave the catheter in place. Pediatric: once the chest cavity is entered, advance the needle and catheter one-quarter inch and no farther, then remove the needle and leave the catheter.
Secure, reassess & document
- Secure the catheter with sterile Vaseline gauze or an appropriate dressing and tape; in a pediatric patient, arrange the gauze at the catheter base to stabilize and seal the site.
- Reassess respiratory status, perfusion, and hemodynamic status. Document the indication, base-contact status or exception, site, procedure, and response.
UNDERSTAND THE CARE
Why the implementation version must be resolved first
July 2026 committee materials describe a planned revision to PR-060/065, but the public procedure index continues to link the older source version. Neither a committee timetable nor an accessible older PDF establishes which version an agency has implemented. Confirm a finalized notice, agency adoption, training and authorized equipment before relying on site, device or technique details. This draft preserves the older source version and does not present the proposed changes as implemented.
Applying the guidance
The educational priority is to connect the qualifying clinical findings to instability, retain the correct adult or pediatric branch, and evaluate the response after intervention. Equipment dimensions, anatomical sites and insertion technique are version-sensitive. They are not expanded into a new landmark drawing here while implementation remains unresolved.
Putting it together
Teaching example: the agency’s rollout instructions differ from the older linked summary. Identify the governing version and resolve the discrepancy through medical direction; do not combine steps from two versions into a hybrid procedure.
Diagram text & teaching checkpoints
- Current authority
- Verify rollout status and agency implementation.
- Clinical indication
- Use the authorized adult/pediatric criteria.
- Procedure version
- Match equipment, site and technique to one version.
- Response
- Reassess and document clinical effect.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Resolve the procedure version as a complete sequence
The version check includes the patient population, qualifying findings, approved device and insertion instructions. A newer equipment package does not by itself establish a new authorized anatomical site. Likewise, an older PDF remaining on the county index does not establish that it is the version your agency now uses.
Keep the governing procedure and agency implementation instruction together during training. If they disagree, resolve the difference before using a combined checklist. This draft intentionally retains the version warning and does not add a new landmark diagram. Record the clinical indication, contact status or documented exception, intervention and response under the authorized procedure.
Sources: PR-060 · PR-065 · Current OCEMS procedure index